>Your ideas are interesting but I feel that we need a proper evidencebased approach to this. There is too much unsubstantiated opinion andemotion associated with this issue. I don't wish to publish ideas thatdo not have proper scientific basis. If you have such please submit as apaper for peer review>Best wishes>>Robin Spiller>>>>>>"Terry S. Singeltary Sr." 08/22/03 09:09pm >>>>>>>

PATIENTS undergoing surgery or endoscopic tests are to be screened for their risk of having the deadly human form of mad cow disease following a series of infection scares last year.

The Chief Medical Officer for Scotland Dr Harry Burns has written to all health boards ordering doctors to identify patients who may have previously been exposed to Creutzfeldt-Jakob Disease (CJD).

Surgeons must now carry out a strict assessment before patients undergo surgical procedures on tissues such as the brain, spinal cord, eye, spleen and tonsils.

The new guidelines come after a series of incidents last year that saw patients who potentially carried CJD undergoing surgery without the proper infection control precautions.

Doctors must now ensure they identify whether patients are at risk of carrying the deadly disease through family contacts, previous surgery or from receiving infected tissues, organs and hormone products.

All patients undergoing procedures on tissues considered to be susceptible to CJD will be asked a series of questions about their potential exposure before elective and emergency surgery.

If they are found to be "at risk" of CJD, extra infection control measures including decontamination of surgical instruments and their disposal will be put in place.

Burns said: "The need for additional advice on pre-procedure assessment was identified by the CJD Incidents Panel following a number of CJD cases in 2005 in which patients underwent surgery without prior knowledge of the need for infection control precautions relating to their special CJD status."

The new guidelines come amid fears that vCJD can be transmitted to patients via infected surgical instruments.

Researchers have called for better logging of the number of times equipment is used and on whom to ensure instruments used on patients later diagnosed with CJD could be taken out of use.

The latest figures show that so far in 2006 there have been 62 suspected cases of CJD in the UK and three people have died from the form caused by eating BSE-infected beef, vCJD.

Since 1995, 156 people have died of vCJD, with 28 dying at the height of the epidemic in 2000. There are currently six living individuals who are suffering from vCJD.

But experts at the National CJD Surveillance Unit at the Western General Hospital in Edinburgh have warned that hundreds more people could die in the next 20 years as a result of contracting vCJD during surgery. Of the 161 people diagnosed with vCJD by the end of 2005, 130 had undergone surgery in the years preceding the start of symptoms.

The government has now allocated £200m to improve sterilisation and tracking of reusable surgical equipment.

Scientists also hope to develop better tests for CJD - which currently requires a tissue sample for analysis - to screen patients when they arrive in hospital.

Dr Ian Stansfield, a CJD researcher at Aberdeen University, said: "Recent research has suggested there may be different types of vCJD that have different incubation times.

"This means we could see waves of epidemics as the other types begin to harm people. As the moment we can only identify patients with CJD if their tissue is found to have the misfolded protein responsible. The trouble is this misfolded protein acts as a catalyst and causes healthy forms of the protein to misfold also, which is what allows the disease to be infectious."

The distribution of PrPSc in the body is different in sporadic andvariant CJD, reflecting the different pathogenesis of the two forms. Inthe case ot sporadic CJD, prion infectivity is largely limited to theCNS (including the retina) and only operations involving the brain andeye have resulted in iatrogenic transmission of the disease.Gastro-intestinal endoscopy is unlikely to be a vector for thetransmission of sporadic CJD as infected tissue is not encounteredduring the procedure. No special precautions are necessary during orafter the procedure and the endoscope should be cleaned and disinfectedin the normal thorough way.4

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i personally believe it is irresponsible for anyone to state in this dayand time, that sporadic CJDs (now at 6 variants) will not transmit thedisease by this route. considering infective dose cannot be quantified,only speculated, such a statement is thus, irresponsible. to hypothosizethat sporadic CJD just happens spontaneously (with no scientific proof),that the PrPSc distribution in tissues of all sporadic CJDs is entirelydifferent than that of vCJD, without being able to quantify the titre ofinfection, or even confirm all the different variants yet, again is_not_ based on all scientific data, then it's only a hypothosis. who isto say that some of these variants of sporadic CJD were not obtained_orally_?

also stated:

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Although thorough cleaning of flexible endoscopes ensures patient safetyfor ''normal'' pathogens, the same process may not be adequate for thePrPSc.

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The sporadic form of CJD affects approximately one person per mil-lionper annum in the population on a worldwide basis.

who is to say how much infectivity are in some of these variants ofsporadic CJDs, without confirming this? if we look at the 6 differentvariants of sporadic CJDs, has the infective dose for all 6 _documented_variants been quantified, and documented as being 'measurable'?

will there be more variants of sporadic CJDs, and what of theramifications from them?

what of other strains/variants of TSE in cattle, BSE in sheep, CWD incattle, or any of the 20+ strains of Scrapies in deer/elk? i get dizzythinking of the different scenerio's. what would the human TSEs fromthese species look like and how can anyone quantify any tissueinfectivity from these potential TSE transmissions to humans, and therisk scenerio described here from this potential route? could not someof these sporadic CJDs have derived directly or indirectly from one ofthese species, and if so, pose a risk by the route described here?

something else to consider, in the recent finding of the incubationperiod of 38 years from a _small_ dose of human growth hormone;

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> We describe the second patient with hGH related CJD in theNetherlands. The patient developed the disease 38 years after hGHinjections. To our knowledge, this is the longest incubation perioddescribed for any form of iatrogentic CJD. Furthermore, our patient was_not_ treated with hGH, but only received a _low_ dose as part of adiagnostic procedure. (see full text below).

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so my quesion is, how low is 'low' in quantifing the infectious dose invCJD, comparing to _all_ sporadic CJDs, from the different potentialroutes, sources, and infectivity dose?

will the titre of infectivity in every tissue and organ of all sporadicCJDs stay exact or constant, no matter what the infective dose, routeand species may be? this is considering you don't buy the fact thatsporadic CJDs 85%+ of _all_ CJDs, are a happen stance of bad luck,happen spontaneously without cause, and are one-in-a-million world wide,with no substantial surveillance to confirm this.

Our data demonstrate that factors in addition to the amount of PrPexpressed determine the tropism of prions for certain tissues. That somemuscles are intrinsically capable of accumulating substantial titers ofprions is of particular concern. Because significant dietary exposure toprions might occur through the consumption of meat, even if it islargely free of neural and lymphatic tissue, a comprehensive effort tomap the distribution of prions in the muscle of infected livestock isneeded. Furthermore, muscle may provide a readily biopsied tissue fromwhich to diagnose prion disease in asymptomatic animals and even humans.

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http://www.pnas.org/

can the science/diagnostic measures used to date, measure this, and atthe same time guarantee that no titre of infectivity exists fromsporadic CJDs (all of the variants), from this potential mode and routeof transmission?

i don't think so, this is just my opinion. this is why i get paidnothing, and these scientists get the big bucks. i just hope i am wrongand the big bucks are correct in their _hypothisis_ of this potentialmode/route of transmission with endoscopy equipment, from _all_ human TSEs.

i understand we have to weigh the risks of what we know to what we don'tknow, to the disease we _may_ catch to what we are having the procedurefor, but to categorically state at this present time of scientificknowledge;

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"Gastro-intestinal endoscopy is unlikely to be a vector for thetransmission of sporadic CJD as infected tissue is not encounteredduring the procedure. No special precautions are necessary during orafter the procedure and the endoscope should be cleaned and disinfectedin the normal thorough way.4"

snip...

but, to categorically state this, in my opinion, is not only wrong, butpotentially very dangerous to the future of human health...TSS